Abstract
BackgroundDespite twinning being common in Africa, few prospective twin studies have been conducted. We studied twinning rate, perinatal mortality and the clinical characteristics of newborn twins in urban Guinea-Bissau.MethodsThe study was conducted at the Bandim Health Project (BHP), a health and demographic surveillance site in Bissau, the capital of Guinea-Bissau. The cohort included all newborn twins delivered at the National Hospital Simão Mendes and in the BHP study area during the period September 2009 to August 2011 as well as singleton controls from the BHP study area. Data regarding obstetric history and pregnancy were collected at the hospital. Live children were examined clinically. For a subset of twin pairs zygosity was established by using genetic markers.ResultsOut of the 5262 births from mothers included in the BHP study area, 94 were twin births, i.e. a community twinning rate of 18/1000. The monozygotic rate was 3.4/1000. Perinatal mortality among twins vs. singletons was 218/1000 vs. 80/1000 (RR = 2.71, 95% CI: 1.93-3.80). Among the 13783 hospital births 388 were twin births (28/1000). The hospital perinatal twin mortality was 237/1000.Birth weight < 2000g (RR = 4.24, CI: 2.39-7.51) and caesarean section (RR = 1.78, CI: 1.06-2.99) were significant risk factors for perinatal twin mortality. Male sex (RR = 1.38, CI: 0.97-1.96), unawareness of twin pregnancy (RR = 1.64, CI: 0.97-2.78) and high blood pressure during pregnancy (RR = 1.77, CI: 0.88-3.57) were borderline non-significant. Sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy.ConclusionsTwins had a very high perinatal mortality, three-fold higher than singletons. A birth weight < 2000g was the strongest risk factor for perinatal death, and unrecognized twin pregnancy was common. Urgent interventions are needed to lower perinatal twin mortality in Guinea-Bissau.
Highlights
Despite twinning being common in Africa, few prospective twin studies have been conducted
Newborn twins constitute a high risk group [1,2], as they are much more likely to suffer from low birth weight, prematurity and distress during labor and delivery [2,3,4]
Bandim health project The study was conducted at the Bandim Health Project (BHP) in Bissau, the capital of Guinea-Bissau
Summary
Despite twinning being common in Africa, few prospective twin studies have been conducted. Newborn twins constitute a high risk group [1,2], as they are much more likely to suffer from low birth weight, prematurity and distress during labor and delivery [2,3,4]. While this is known for all settings, including highincome countries [2,5], the effect becomes more pronounced in areas with inadequate pre- and postnatal care [1]. Twins remain an important target group for interventions in Sub-Saharan Africa and require particular attention In this regard it is especially important to identify risk factors for twin mortality. There is a need of prospective cohort studies focusing on the epidemiological and clinical aspects of twinning
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